目的 探讨围手术期超前平衡镇痛在肛肠手术中止痛的临床效果。方法 回顾性分析2009年11月至2010年10月期间巴中市中医院肛肠科123例采用腰俞穴麻醉的肛肠手术患者的临床资料，患者被分成超前平衡镇痛组（60例）和传统镇痛组（63例）2组。2组术前准备相同，术后均口服布洛芬缓释胶囊300mg止痛，2次/d。对Ⅲ～Ⅳ度内痔及内括约肌痉挛的患者术中均常规行内括约肌松解术，对VAS评分6分以上的患者选择使用盐酸曲马多注射止痛。超前平衡镇痛组术前0.5h肌注安定10mg，口服布洛芬缓释胶囊300mg，术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml、芬太尼50 μg、地塞米松5mg用生理盐水稀释成20ml行腰俞穴麻醉并止痛，术毕肛内塞用双氯芬酸钠栓1枚。传统镇痛组术中采用2%盐酸利多卡因5ml、0.75%盐酸布比卡因5ml用生理盐水稀释成20ml行腰俞穴麻醉。比较2组术后4、6、8、12、24及48 h VAS评分、盐酸曲马多使用率及恶心、呕吐及尿潴留的发生率。结果 术后4、6、8、12、24及48 h VAS评分超前平衡镇痛组均明显低于传统镇痛组（P＜0.01），术后盐酸曲马多使用率超前平衡镇痛组明显低于传统镇痛组（P＜0.05），恶心、呕吐及尿潴留的发生率2组比较差异均无统计学意义（P＞0.05）。结论 围手术期超前平衡镇痛用于肛肠手术止痛是一种疗效肯定、安全、不良反应少而又简单易行的镇痛方法。
Objective To evaluate the effectiveness of intravenous patient-controlled analgesia versus epidural patient-controlled analgesia for postoperative analgesia, sedation, and the incidence of side effects. Methods We searched the specialized trials registered in the Cochrane anesthesia group, The Cochrane Library (CCTR), MEDLINE (1966 to Sept. 2008), EMbase (1966 to Sept. 2008), PubMed (1966 to Sept. 2008), and handsearched some Chinese anesthesia Journals and Clinical anesthesia journals. Randomized controlled trials (RCTs) and quasi-RCTs of intravenous versus epidural analgesia for post-operation were included. The quality of the trials was critically assessed. RevMan 4.2.8 software was used for meta-analyses. Results Thirteen RCTs involving 580 patients of intravenous versus epidural analgesia for post-operation were included. The results of meta-analyses showed that there were no significant differences in postoperative analgesia and sedation at the hour-points of 2nd, 4th, 8th, 12th, and 24th hours after operation. There were no significant differences in plasma fentanyl concentration in the two groups on the same analgesia effects. There were also no significant differences in side effects. Conclusion Both intravenous patient-controlled analgesia and epidural patient-controlled analgesia have the same clinical effects. Compared with epidural patient-controlled analgesia, intravenous patient-controlled analgesia has fewer side effects and is more convenient. At the same time, it can reduce more costs of hospitalization. But because of the low quality and small sample size of the included studies, more well-designed, large scale, randomized controlled trials are needed.
Objective To evaluate the efficacy of intravertebral analgesia for external cephalic version. Methods We electronically searched The Cochrane Library (Issue 4, 2009), PubMed (1980 to 2009), Ovid MEDLINE (1950 to 2009), Ovid EBM Database (1991 to 2009), EMbase (1980 to 2009), CBM (1978 to 2009) and CNKI (1979 to 2009) to collect literature about intravertebral analgesia for external cephalic version. We screened randomized controlled trials (RCTs) according to the predefined inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies, and then performed meta-analyses by using RevMan 5.0.13 software. Results Seven RCTs involving 620 women met the inclusion criteria. Five trials were of relatively high quality, and 1 of low quality and 2 not clear. The result of meta-analyses showed that intravertebral analgesia was superior in external cephalic version with a RR 1.53 and 95%CI 1.24 to 1.88. Conclusion Intravertebral analgesia can increase the successful rate of external cephalic version in the treatment of breech presentation compared with intravenous medicine for systematic use or no analgesia.
Objective To investigate the effects of cryoanalgesia for post-thoracotomy pain on the intercostal nerves. Methods Two hundred and eight patients suffering from thoracotomy were divided into three groups, according to different analgesia received respectively. Cryoanalgesia group （n = 80）： cryoanalgesia on the intercostal nerves, intercostals nerves was freezed at -55 ℃ for 90 seconds ; patient controlled analgesia by vein （PCA group, n= 80）： patient controlled analgesia was practiced intravenously, and control group （n = 48）： Dolantin given irregularly intra-muscularly and/or tramadol orally. Severity of pain was graded by visual analogue scale. Forced expiratory volume in one second（FEV1.0） was measured and pulmonary complication after operation was compared. Results There was a statistically significant improvement in postoperative pain scores and an improvement in respiratory function tests for patients in cryoanalgesia group（X2 = 74.93,15.04,P〈0. 05）. FEV1.0 in cryoanalgesia group was significantly higher than that in control group（1. 97±0.27L vs. 1. 39±0. 14 L,P〈0. 05）. Pulmonary complication in cryoanalgesia group after operation was lower than that in control group （6. 25% vs. 31. 25%, P〈0. 05 ）, Conclusion Cryoanalgesia on post-thoracotomy pain is very effective and may improve the respiratory function after operation.
Objective To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.
Transcuataneous electrical nerve stimulation (TENS) analgesia as a non-drug method has received people's more and more attention recently. Considering problems of existing products, such as unstable performance and unsatisfied effectiveness, we developed a new analgesia therapy system for delivery based on bio-feedback TENS in our laboratory. We proposed a new idea for stimulation signal design, that is, we modulated a middle frequency signal by a traditional low frequency TENS wave in the new system. We designed different prescription waves for pain relief during a uterine contraction or massage between contractions. In the end, a bio-feedback TENS method was proposed, in which the waveforms of stimulation signals were selected and their parameters were modified automatically based on feedback from uterine pressure, etc. It was proved through quality tests and clinical trials that the system had good performance and satisfied analgesia effectiveness.
【摘要】 目的 观察不同剂量的舒芬太尼用于剖宫产术后硬膜外自控镇痛的效果比较。 方法 将2009年4-11月60例硬膜外麻醉下行剖宫产手术术后的患者随机分为三组，术后镇痛液A组采用0.125%罗哌卡因复合0.3 μg/mL舒芬太尼；B组为0.125%罗哌卡因复合0.4 μg/mL舒芬太尼；C组0.125%罗哌卡因复合0.5 μg/mL舒芬太尼，观察三组患者的术后镇痛效果（视觉模拟法评分，即VAS评分）及不良反应。 结果 A组VAS评分高于B组和C组，B组VAS评分高于C组（Plt;0.05）。三组患者术后恶心呕吐、运动阻滞、嗜睡及肠蠕动抑制等并发症无统计学差异（Pgt;0.05）。 结论 0.125%罗哌卡因复合0.5 μg/mL舒芬太尼以4 mL/h持续输注用于剖宫产术后患者自控硬膜外镇痛术后疼痛VAS评分最小，患者镇痛满意度最高。【Abstract】 Objective To observe the effect of postoperative patient-controlled epidural analgesia (PCEA) with three different doses of sufentanil combined with 0.125% ropivacaine after cesarean section. Methods Data was collected from April 2009 to November 2009. Sixty patients after cesarean section under continuous epidural anesthesia were randomly divided into three different groups.Group A was given sufentanil 0.3 μg/mL and 0.125% ropivacaine for PCEA, group B was given sufentanil 0.4 μg/mL and 0.125% ropivacaine, group C was given sufentanil 0.5 μg/mL and 0.125% ropivacaine. The analgesia effects were evaluated by the visual analogue scales (VAS). Side effects were also recorded. Results The VAS scores were significantly the highest in group A than that in group B and group C, the VAS scores in group B were higher than that in group C (Plt;0.05). The incidence of side effects, such as postoperative nausea and vomiting, lethargy, and pruritus, was not significant among the three groups (Pgt;0.05). Conclusion 0.5 μg/ mL sufentanil and 0.125% ropivacaine recommended for PCEA with background 4 mL/h is safe and effective for patients after cesarean section.
Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.